Wrong route errors: Are you heading in the wrong direction?
By Mary-Jo Doolan, MSN RN
Chair, Congress on Nursing Practice

In June 1999 the Massachusetts Coalition for the Prevention of Medical Errors published its first issue of Safely First which focused on wrong route errors. The purpose of these Safety First publications is to alert the health care community to strategies for preventing errors known to have occurred in Massachusetts and across the country. Here is a brief outline of the problems identified regarding wrong route errors and what you can do to minimize the opportunity for error in your institution.

Following are a list of problems identified and suggestions for what you can do to minimize the opportunity for error in your institution

Enteral formulas given parenterally

• Do not interchange enteral tubing and IV tubing
• Use tubing and bags designed for enteral feed administration only
• Ensure that pumps used to deliver IV medications are different from pumps used to deliver enteral feeds

• Never give oral medications intravenously
• Review dosage forms and route of administration with all staff involved in administering medications
• Review medication administration competencies and discuss the implications of this kind of error with staff
• Intravenous medication administered intrathecally
• Facilitate proper identification and proper route of administration by the end user with special packaging of all medications intended for intrathecal administration
• Provide medications in a ready-to-administer form
• Prepare and administer intravenous and intrathecal medications in different locations when possible

Intramuscular preparations administered intravenously

• Make information about medications clear, current and readily available to all staff
• Alert staff to additional drug information and warnings for all non-formulary and/or infrequently used medications
• Have pharmacy attach auxiliary labels indicating that the drug is to be administered via the intramuscular route only
• Make all staff aware of policies regarding IM administration and consult with pharmacy when the final volume is greater than the allowed volume to be administered via this route
• Question orders for non-formulary medications and recommend a formulary alternative
  

Epidural and intravenous lines mix-up

• Label each line at the connecting end

Using IV syringes to measure doses of oral medication

• Use an oral syringe for measuring when administering oral medications
• Test oral syringes in use to ensure that they are designed with a tip that prevents connecting the syringe to the needleless IV sets

• Have pharmacy prepare all oral doses when IV medications must be used
• Repackage the medication in an amber bottle or oral syringes
• Do not send vials to the patient care area
• Examine labels generated by the pharmacy to ensure that they do not continue to list this as an IV product
• Attach appropriate labels such as FOR ORAL USE ONLY
• Have the dose changed whenever possible so that commercially available oral products can be used